Provider Demographics
NPI:1386740991
Name:FREDAL, THOMAS MICHAEL (DDS)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:MICHAEL
Last Name:FREDAL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7777 25 MILE ROAD
Mailing Address - Street 2:
Mailing Address - City:SHELBY TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48316-1818
Mailing Address - Country:US
Mailing Address - Phone:586-731-8383
Mailing Address - Fax:586-731-6197
Practice Address - Street 1:7777 25 MILE RD
Practice Address - Street 2:
Practice Address - City:SHELBY TWP
Practice Address - State:MI
Practice Address - Zip Code:48316-4831
Practice Address - Country:US
Practice Address - Phone:586-731-8338
Practice Address - Fax:586-731-6197
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010144101223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice